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For m A RP Ark. Code Ann. 119403, 407 ACC Rule7 Updated: 061614ARKANSAS WORKERS COMPENSATION COMMISSION 324 Spring Street, Little Rock, AR 72201 Mail: P. O. Box 950, Little Rock, AR 722030950 Little

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How to fill out arkansas workers compensation 11-9-403

01

Start by entering the name of the injured worker at the top of the form.

02

Provide details about the injury, including the date and time it occurred.

03

Specify the body part that was injured and the type of injury sustained.

04

Include information about the medical treatment received by the injured worker.

05

Fill out the section about the employer and insurance carrier involved in the workers compensation claim.

06

Sign and date the form once all the required information has been entered.

Who needs arkansas workers compensation 11-9-403?

01

Employees who have been injured on the job in Arkansas and are seeking workers compensation benefits.

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What is arkansas workers compensation 11-9-403?

Arkansas workers compensation 11-9-403 is a form used to report workers' compensation claims in the state of Arkansas.

Who is required to file arkansas workers compensation 11-9-403?

Employers in Arkansas are required to file arkansas workers compensation 11-9-403 for any workers' compensation claims.

How to fill out arkansas workers compensation 11-9-403?

The form can be filled out online or submitted through mail with all the required information about the workers' compensation claim.

What is the purpose of arkansas workers compensation 11-9-403?

The purpose of arkansas workers compensation 11-9-403 is to ensure that workers' compensation claims are properly documented and reported.

What information must be reported on arkansas workers compensation 11-9-403?

The form requires information about the injured employee, the nature of the injury, and the circumstances surrounding the injury.

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